Hyperacute graft dysfunction in an orthotopic heart transplant in the presence of non-HLA antibodies.
autoantibody
clinical research/practice
health services and outcomes research
heart transplantation/cardiology
patient characteristics
patient survival
rejection
risk assessment/risk stratification
Journal
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
ISSN: 1600-6143
Titre abrégé: Am J Transplant
Pays: United States
ID NLM: 100968638
Informations de publication
Date de publication:
02 2020
02 2020
Historique:
received:
01
05
2019
revised:
11
07
2019
accepted:
04
08
2019
pubmed:
11
8
2019
medline:
20
2
2021
entrez:
11
8
2019
Statut:
ppublish
Résumé
Antibody-mediated rejection (AMR) in heart transplants in the absence of anti-HLA donor-specific antibody (DSA) is not well studied or documented. This case reviews hyperacute fulminant graft dysfunction suspected to be mediated by non-HLA antibodies. After cross clamp removal, the patient developed severe pulmonary edema, profound coagulopathy, and biventricular failure. The patient's presumed AMR, cardiogenic shock, and coagulopathy were treated with extracorporeal membrane oxygenation (ECMO), plasmapheresis, intravenous immunoglobulin (IVIG), multiple blood products, and prothrombin complex concentrate. The recipient was 0% panel-reactive antibody (PRA), ABO, and crossmatch compatible. Intraoperative biopsy sample revealed a thrombotic process suggestive of a coagulation pathway activated by AMR; however, no C4d deposition was detected. Postmortem biopsies also suggested AMR. Retrospective testing of the patient's pretransplant serum revealed strong antiangiotensin II type 1 receptor (AT1R) antibodies and a strongly positive endothelial cell crossmatch. Anti-AT1R antibodies are known to be AT1 receptor agonists and may trigger inflammation and activate the extrinsic coagulation pathway. Given the potential effects of signaling through the AT1R, the patient's preexisting anti-AT1R antibodies and procoagulant therapy may have adversely affected the patient's clinical course.
Identifiants
pubmed: 31400258
doi: 10.1111/ajt.15564
pii: S1600-6135(22)22213-8
doi:
Substances chimiques
HLA Antigens
0
Receptor, Angiotensin, Type 1
0
Types de publication
Case Reports
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
593-599Informations de copyright
© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.
Références
Kobashigawa J, Colvin M, Potena L, et al. The management of antibodies in heart transplantation: an ISHLT consensus document. J Heart Lung Transplant. 2018;37:537-547.
Colvin M, Cook J, Zeevi A, et al. Antibody-mediated rejection in cardiac transplantation: emerging knowledge in diagnosis and management. A scientific statement from the American Heart Association. Circulation. 2015;131:1608-1639.
Banan B, Mohanakumar T. Increased sensitization to HLA and to cardiac self-antigens (myosin and Vimentin) in patients waiting for cardiac transplantation with left ventricular assisting Device (LVAD) [Abstract]. J Heart Lung Transplant. 2014;S25:47.
von Salisch S, Markus J. Identification of non-HLA antibodies in ventricular assist device recipients. J Heart Lung Transplant. 2012;S46:82-99.
Hickey M, Reed E. Antibodies to angiotensin type II receptor I are associated with primary graft dysfunction after orthotopic heart transplant in patients with ventricular assist device as bridge to transplant. In: Proceedings from the 2017 American Transplant Congress; April 29-May 3, 2017; Chicago, IL. Abstract 225.
Urban M, Netuka I. The impact of angiotensin II type 1 receptor antibodies on post-heart transplantation outcome in heart mate II bridged recipients. Interact Cardiovasc Thorac Surg. 2016;22:292-297.
Zhang X, Reinsmoen N. Revealing a new mode of sensitization induced by mechanical circulatory support devices: impact of anti-AT1R antibodies. Clin Transplant. 2018;32:e13178.
Hiemann NE, Meyer R, Dragun D, et al. Non-HLA antibodies targeting vascular receptors enhance alloimmune response and microvasculopathy after Heart Transplantation. Transplantation. 2012;94(9):919-924.
Reinsmoen N, Lai CH, Kobashigawa J, et al. Increased negative impact of donor HLA-specific together with non-HLA-specific antibodies’ on graft outcome. Transplantation. 2014;97:595-601.
Dragun D, Wallukat G. Angiotensin II type 1-recetor activating antibodies in renal-allograft rejection. N Engl J Med. 2005;352:558-569.
Senchenkova E, Granger D. Angiotensin II-mediated microvascular thrombosis hypertension. Hypertension. 2010;56(6):1089-1095.
Dragun D, Catar R, Philippe A. Non-HLA-antibodies targeting angiotensin type 1 receptor and antibody mediated rejection. Clinic for Nephrology and Intensive Care Medicine, Campus Virchow-Klinikum and Center for Cardiovascular Research, Medical Facility of the Charite, Berlin Germany. Hum Immunol.2012;73:1282-1286.
Butler C, Valenzuela N, Reed E, et al. Not all antibodies are created equal: factors that influence antibody mediated rejection. J Immunol Res. 2017;2017:7903471.
Zhang X, Reinsmoen N. Impact of non-human leukocyte antigen-specific antibodies in kidney and heart transplantation. Front Immunol. 2017;8:434.
Zhang Q, Elaine R. The importance of non-HLA antibodies in transplantation. Nat Rev Nephrol. 2016;12(8):484-495.
Coutance G, Varnous S. Late antibody-mediated rejection after heart transplantation: mortality, graft function, and fulminant cardiac allograft vasculopathy. J Heart Lung Transplant. 2015;34:1050-1057.
Clerkin K, Mancini D. Donor specific anti-HLA antibodies with antibody mediated rejection and long-term outcomes following heart transplantation. J Heart Lung Transplant. 2017;36(5):540-545.
Reinsmoen N, Dragun D, Wang Q. Anti-angiotensin type 1 receptor antibodies associated with antibody mediated rejection in donor HLA antibody negative patients. Transplantation. 2010;90:1473-1477.
Giral M, Dragun D. Pretansplant sensitization against angiotensin II type 1 receptor is a risk factor for acute rejection and graft loss. Am J Transplant. 2013;13:2567-2576.
Philogene M, Bagnascko S, Jackson A. Anti-angiotensin II type 1 receptor and anti-endothelial cell antibodies: a cross-sectional analysis of pathological findings in allograft biopsies. Transplantation. 2017;101:608-615.
Shamseddin MK. Can't always blame anti-HLA antibody: angiotensin II type 1 receptor (AT1R) antibody and renal allograft vascular rejection. J Nephrol Urol. 2017;1(1):3.
Lemp N, Kasahara N. P142 hyperacute rejection in a kidney transplant recipient with no HLA antibodies. Hum Immunol. 2016;77:140.
Pohlmeyer C, Wald D. P216 Case of suspected hyperacute renal transplant rejection due to angiotensin II type 1 receptor antibodies. Hum Immunol. 2017;78:215.
Jackson AM, Kuperman MB, Montgomery RA. Multiple hyperacute rejection in the absence of detectable complement activation in a patient with endothelial cell reactive antibody. Transplantation. 2012;12(6):1643-1649.
Cozzi E, Calabrese F, Rea F, et al. Immediate and catastrophic antibody-mediated rejection in a lung transplant recipient with anti-angiotensin II receptor type I and anti-endothelin-1 receptor type A antibodies. Am J Transplant. 2017;17:557-564.
Ismael-Badarneh R, Guetta J, Azzam Z, et al. The role of angiotensin II and cyclic AMP in alveolar active sodium transport. PLoS ONE. 2015;10(7):e0134175.
Imai Y, Penninger J. Angiotensin-converting enzyme 2 protects from severe acute lung failure. Nature. 2005;436:112.
KCENTRA® (Prothrombin Complex Concentrate (Human)) [package insert]. Kankakee, IL: CSL Behring LLC; 2013.
Mackman N. The role of tissue factor and factor VIIIa in hemostasis. Anesth Analg. 2009;108(5):1447-1452.